First-of-its-kind analysis of US national data reveals significant disparities in individual well-being as measured by lifespan, education, and income.
White males make up largest share of the group with lowest well-being while American Indian and Alaska Native individuals, and Black males, face the most significant challenges to overall well-being.
Populations at the lowest levels of well-being across the US are especially concentrated in the Deep South, Appalachia, and the Rust Belt.
The Institute for Health Metrics and Evaluation (IHME) has published a new study published in The Lancet that finds significant disparities in well-being among racial and ethnic groups, and across sex and age groups. In the first analysis of its kind, the Human Development Index (HDI) was adapted to examine trends and inequities at the individual rather than the group level from 2008 to 2021.
Published by the United Nations Development Programme (UNDP), the HDI is an indicator of well-being composed of lifespan, education, and income and a statistical measurement of a country's average achievements in these three areas. IHME's adaptation of HDI used data from the American Community Survey (ACS) to estimate years of education and household spending, combined with life expectancy estimates based on death records, to estimate expected lifespan.
Significant disparities in HDI by race and ethnicity and by sex.
Although average HDI increased gradually from 2008 to 2019 for all demographic groups—with a decline in 2020 due to decreases in lifespan—and people of every race and ethnicity and sex can be found at both highest and lowest HDI segments, disparities in HDI were observed by race and ethnicity and by sex. American Indian and Alaska Native males and females, Black males, and Latino males are most likely to experience the lowest levels of well-being in the nation, while Asian Americans and White females are most likely to experience the highest levels of well-being.
Among American Indian and Alaska Native males, one in two were in the lowest HDI group (the lowest 10% of the population), while approximately one of every four American Indian and Alaska Native females were in this segment. Among Black Americans, 40% of males were in the lowest HDI segment, while among the Latino population, 21% of males were in the lowest group. Only 8% of White males were in the lowest HDI segment; however, as the White population is the largest racial and ethnic group in the US, White males were the largest population group in the lowest HDI segment (27%).
The study also highlighted stark geographical differences in the distribution of HDI within the US population, with people living in parts of the southern US, Appalachia, and the Rust Belt states over-represented in the lowest segment. In contrast, people living in parts of Colorado, Maryland, New York, California, Virginia, and Washington, DC, were over-represented in the highest segment.
"As a new federal administration prepares to take actions aimed at solving the most pressing economic, social, and health issues the US population faces, this study underscores the urgent need for action by policymakers, educators, and public health experts," said Dr. Christopher J.L. Murray, Director of the Institute for Health Metrics Evaluation. "IHME's findings further emphasize the critical need to develop highly targeted social programs to dismantle deep-rooted structural inequalities in the US," he added.
HDI analysis suggests vast intergenerational differences in racial and ethnic and sex disparities.
The study's findings by age group highlight notable differences, including shifts in demographics accounting for the lowest HDI segments: predominantly male in younger age groups, and predominantly female among older age groups. For example, while only 5% of the highest HDI segment among those aged 25-44 was made up of White males, this figure dramatically increases to 49% among those aged 85 and older, illustrating profound changes in the makeup of the best (and worst) off across different age groups.
"The disparities highlighted in our study are not merely statistics but a call for action, highlighting the long-term societal consequences of ignoring these gaps, particularly among the most affected groups and regions," said study author and IHME Associate Professor Laura Dwyer-Lindgren. "Historical, systemic inequalities in access to opportunities must be addressed to reduce economic and social inequalities and ensure a healthier, more inclusive future for all," she concluded.
Time trends in US education, household consumption, and lifespan
All racial and ethnic groups saw an increase in average years of education, with the largest gains among Latino females (+0.9 years) and males (+0.8 years), who had the lowest starting levels. The increase was larger for females than for males in every racial and ethnic group; among most racial and ethnic groups, younger females had higher education levels than their male counterparts, while the trend reversed in older age groups.
For household consumption—a measure of household income that accounts for household size—similar patterns were observed across race and ethnicity and sex groups, with an initial decline from 2008 until approximately 2011, followed by an increase through 2019 or 2020, and a second decline through 2021.
When analyzing life span, Asian American females led with the longest expected lifespan (88.6 years), while AIAN males (77.0 years) and Black males (77.4 years) had the shortest. In every racial group, females lived longer than males. The expected lifespan rankings stayed the same for both males and females: Asian Americans lived the longest, followed by Latino, White, Black, and AIAN populations.
The COVID-19 pandemic drove decreases in lifespan and HDI from 2019 to 2020 in every race and ethnicity and sex group, but the size of the decrease was notably larger in historically marginalized populations, probably in part due to their increased likelihood of performing essential work or living in higher-exposure conditions. Health crises such as the COVID-19 pandemic underscore the need for more sustainable progress, emphasizing that improvements in societal well-being are not guaranteed and require continuous, focused action to ensure lasting change.
This Article is one of five expected analyses from the Global Burden of Disease Study 2021 focused on health in the USA. All five papers will be included in a special print issue of The Lancet dedicated to health and policy in the USA scheduled to be published on 5 December 2024.
For access to the Article after the embargo lifts at 23:30 UK time on November 7, 2024, please see: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01757-4/fulltext - PLEASE NOTE POST-EMBARGO PAPER LINK WILL NOT WORK UNTIL THE EMBARGO LIFTS.
